Phenobarbital Toxicity and Mechanism of Action
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Questions and Answers

What is the common adverse effect associated with Phenobarbital?

  • Thrombocytosis
  • Transient hair growth
  • Nausea and vomiting (correct)
  • Decreased appetite
  • Which of the following is a characteristic of Phenobarbital pharmacokinetics?

  • Long plasma half-life (correct)
  • High brain protein binding
  • Rapid onset of action
  • Short duration of action
  • What is the mechanism of action of Phenobarbital in the CNS?

  • Enhances excitatory transmission
  • Increases inhibitory neurotransmitters (correct)
  • Decreases inhibitory neurotransmitters
  • Blocks GABA receptors
  • Which of the following is a contraindication for Phenobarbital use?

    <p>Pregnancy</p> Signup and view all the answers

    In what type of seizures is Phenobarbital commonly used?

    <p>Partial seizures</p> Signup and view all the answers

    'Increases the inhibitory neurotransmitters (e.g: GABA ) and decreases the excitatory transmission' - This statement is associated with the mechanism of action of:

    <p>'Phenobarbital'</p> Signup and view all the answers

    What is the mechanism of action of benzodiazepines?

    <p>Increasing chloride ion channel opening frequency</p> Signup and view all the answers

    What is a common side effect of barbiturate overdose?

    <p>Tachycardia</p> Signup and view all the answers

    Which barbiturate is associated with atonic and infantile spasms?

    <p>Phenobarbital</p> Signup and view all the answers

    Which benzodiazepine is specifically used for absence seizures?

    <p>Clonazepam</p> Signup and view all the answers

    What clinical use is associated with mephobarbital?

    <p>Infantile spasms</p> Signup and view all the answers

    How do barbiturates affect the CNS and respiratory system during toxicity?

    <p>Induce Cheyne-Stokes respiration</p> Signup and view all the answers

    What is the main route of excretion of Phenobarbital?

    <p>Urinary excretion</p> Signup and view all the answers

    What is a common side effect associated with Phenobarbital toxicity?

    <p>Gastrointestinal upset</p> Signup and view all the answers

    How does Phenobarbital affect the brain's GABA content?

    <p>Increases GABA content</p> Signup and view all the answers

    In CNS disorders, Phenobarbital is particularly effective against which type of seizures?

    <p>Absence seizures</p> Signup and view all the answers

    What is one of the mechanisms of action of barbiturates like Phenobarbital in the brain?

    <p>Facilitation of GABA activity</p> Signup and view all the answers

    Which drug should not be given concomitantly with Phenobarbital due to its metabolism being inhibited by Phenobarbital?

    <p>Valproic Acid</p> Signup and view all the answers

    Study Notes

    Phenobarbital

    • Mechanism of action: increases inhibitory neurotransmitters (e.g., GABA) and decreases excitatory transmission, prolongs the opening of Cl- channels, and blocks excitatory responses induced by glutamate
    • Side effects: nausea, vomiting, GIT disturbances, increased appetite and weight gain, transient hair loss, hepatotoxicity, thrombocytopenia, and neural tube defects in offspring of women
    • Pharmacokinetics: long-acting barbiturate, 20-45% protein-bound, low lipid solubility, and hepatic microsomal enzyme system metabolism
    • Plasma half-life: 53-118 hours (adults), 60-180 hours (children and newborns)
    • Uses: partial seizures and generalized tonic-clonic seizures, but little effect on absence, atonic, and infantile spasms

    Benzodiazepines

    Diazepam

    • Mechanism of action: interacts with specific receptors on the GABAA receptor–chloride ion channel macromolecular complex
    • Uses: generalized tonic-clonic and status epilepticus
    • Pharmacokinetics: well-absorbed, widely distributed, extensively metabolized to many active metabolites
    • Plasma binding: 95%
    • Half-life: 20-40 hours
    • Toxicity: sedation, drowsiness, and lethargy, strong inducing agent

    Lorazepam

    • Uses: status epilepticus
    • Pharmacokinetics: rapidly and extensively distributed
    • Plasma binding: 85%
    • Half-life: 20-40 hours

    Clonazepam

    • Uses: absence seizures
    • Pharmacokinetics: well-absorbed, widely distributed, extensively metabolized
    • Plasma binding: 85%
    • Half-life: 20-40 hours

    Nitrazepam

    • Uses: infantile spasms, myoclonic seizures
    • Pharmacokinetics: well-absorbed, widely distributed, extensively metabolized
    • Plasma binding: 80%
    • Half-life: 20-40 hours

    Clorazepate Dipotassium

    • Uses: complex partial seizures
    • Pharmacokinetics: well-absorbed, widely distributed, extensively metabolized
    • Plasma binding: 90%
    • Half-life: 20-40 hours

    Carbamazepine

    • Mechanism of action: interacts with voltage-gated Na+ channels, increases K+ conductance
    • Pharmacokinetics: well-absorbed, widely distributed, extensively metabolized
    • Plasma binding: 70-80%
    • Half-life: 30 hours
    • Toxicity: GI upset, drowsiness, ataxia, headache, diplopia, hepatotoxicity, congenital malformations, hyponatraemia, water intoxication, and late hypersensitivity reaction

    Sodium Valproate (Valproic Acid)

    • Mechanism of action: increases GABA content in the brain, attenuates Ca-mediated T current, and prolongs Na+ channel inactivation
    • Pharmacokinetics: available as capsule, syrup, and IV, high oral bioavailability, inhibits metabolism of several drugs
    • Plasma half-life: approximately 15 hours
    • Clinical use: effective against absence, myoclonic, and generalized tonic-clonic seizures, less effective for partial seizures, and used for mania treatment

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    Description

    Learn about the toxicity effects of Phenobarbital, such as nausea, vomiting, weight gain, and hepatotoxicity. Understand how Phenobarbital increases inhibitory neurotransmitters and decreases excitatory transmission by prolonging the opening of Cl- channels. Explore its mechanism of action and potential neural tube defects in offspring.

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